Investing in Health: African Countries Expand Domestic and Innovative Financing

This week, President Barack Obama is hosting the first ever U.S.-Africa Leaders Summit in Washington, D.C., welcoming leaders from across the African continent to discuss trade and investment, with an eye toward security, peace and democratic development. Importantly, these high-level meetings will also include discussions of the future of global health investments and the U.S.-Africa partnership in reaching an AIDS-free generation.

The recent report by the Center for Strategic and International Studies, titled Africa in the Wider World, notes that "some of the United States' most vital and impactful relationships with Africa are in the health sector." To that end, this week's summit provides an opportunity to reflect on the progress made through U.S. investments in institutions such as the President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to discuss the best way forward in improving health interventions in Africa, and to pave the way for continued economic growth in the region.

At the Summit, and looking toward the future, it's important to remember that this kind of progress requires investments from all stakeholders. Tremendous advancements have been made against diseases such as AIDS, tuberculosis and malaria; however, as we move from an emergency response to one of sustainability -- and as international aid begins to level out -- domestic expenditures for health will become increasingly vital.

In order to sustain momentum in the fight against the three diseases over the long term, an increasing level of funding will need to come from implementing countries. That is why the Global Fund and other international institutions are making domestic resource mobilization an important component of their outreach strategies.

By way of example, in the lead-up to its Fourth Voluntary Replenishment Conference in December, the Global Fund worked with African heads of state to champion resource mobilization and domestic investments in health, with several countries making significant commitments. For example, Nigeria announced $150 million in new investments in its own HIV prevention and treatment. This was in addition to its $1 billion commitment as part of the "Saving One Million Lives" campaign. Nigeria also pledged $30 million to the Global Fund.

There were other notable contributions during the replenishment: Kenya pledged $2 million; Zimbabwe pledged $1 million; Namibia pledged $1 million; and Malawi pledged $500,000. These domestic investments are a strong signal of partnership.

Of course, given the changing political climates and fiscal and economic challenges in these countries, complete domestic takeover of financing is not a reality in the short term. But there is progress. Between 2006 and 2011, global domestic investment doubled spending on AIDS, tuberculosis and malaria. Over 80 countries increased domestic investments for the AIDS response by more than 50 percent between 2006 and 2011. Similarly, domestic funding for tuberculosis care and control in 104 countries increased in aggregate by more than 30 percent from 2006 to 2011. Over the same period, domestic funding for malaria control increased by nearly 40 percent.

In addition, there is growing political will and leadership to develop new and innovative financing for health. For example, in 1999 Zimbabwe introduced an AIDS levy which has increased significantly since the adoption of the country's multicurrency system, growing from $5.7 million in 2009 to $26.5 million in 2012. Projections indicate that it will grow to $47 million in 2016. Other countries in sub-Saharan Africa, including Kenya, Zambia and Tanzania, are looking into similar mechanisms and trust funds.

Though we still have a long way to go, domestic spending increases among African Union nations demonstrate growing political will -- a sign that we are right on track. Most importantly, it sends a strong political message to international donors that their investments are working: the programs they support are gradually building healthier communities and enabling countries to take greater control of their health systems in a sustainable way.


Derrick is the president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, an advocacy organization dedicated to sustaining and expanding U.S. support for the Global Fund. A global health thought leader with nearly two decades of policy and international development experience, Derrick serves on the board of the NGO alliance InterAction, and previously served as a senior program officer at the Bill & Melinda Gates Foundation.